Senate Republicans are making one last desperation push torepeal Obamacare but face significant challenges to get it donebefore a final deadline at the end of the month.

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A number of Republicans are jumping on board a proposal by Senators Lindsey Graham ofSouth Carolina and Bill Cassidy of Louisiana to replace theAffordable Care Act’s insurance subsidies with block grants tostates, which would decide how to help people get health coverage.But some of the same GOP senators who blocked various stages ofearlier repeal efforts are withholding their support. Two monthsago, Majority Leader Mitch McConnell’s effort to pass a replacementwith only Republican support suffered a spectacular defeat in theSenate. When members of the Senate health committee then beganworking on a bipartisan plan to shore up Obamacare, Graham andCassidy revved up a new bid to get their GOP-only bill to theSenate floor.Democrats are warning that the bill is a seriousthreat.

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"This is not a drill," Senate Democratic leader Chuck Schumer ofNew York wrote on Twitter Monday. "The GOP is back w/ anotherversion of #Trumpcare & it’s no better than their last plan.It’s worse."

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The measure would end Obamacare’s requirements that individualsobtain health insurance and most employers provide it to theirworkers, and give states broad flexibility to address the needs ofpeople with pre-existing medical conditions. The proposal would endthe Affordable Care Act’s tax on medical devices while keepingothers intact, including taxes on the wealthy, to fund the blockgrants.

No Democratic support

Because the Graham-Cassidy plan has no Democratic support,Republicans have only until Sept. 30 to push it through the Senatebefore rules expire that allow it to be passed with 50 senatorsplus Vice President Mike Pence’s tiebreaking vote. Republicanscontrol the Senate 52-48.

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Graham said last week that McConnell said he was “all in” tohelp the two bill sponsors round up the 50 votes to pass the bill.Graham said they could have as many as 48 votes if the vote wereheld now. But a number of Republican senators have yet to get onboard, including the three who defeated McConnell’s plan -- SusanCollins of Maine, Lisa Murkowski of Alaska and John McCain ofArizona.

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Senator Rand Paul, a Kentucky Republican, has come out againstit, tweeting his opposition Friday and again on Monday.

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“No conservative should vote for a rebranded trillion dollarspending program just because it adds some block grants,” Paulwrote Monday on Twitter. He added moments later, “Graham/Cassidykeeps Obamacare and tells the states to run it. No thanks.”

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Because the plan keeps most of Obamacare’s taxes, theconservative group Heritage Action is urging Republicans to blockit.

McCain undecided

McCain said last week he would consider supporting the plan, butwas waiting for input from Arizona’s GOP Governor Doug Ducey. OnSunday, McCain repeated his view that a health plan needs to gothrough the committee process and gain bipartisan support -- bothof which are unlikely with the clock ticking and Democrats unitedagainst an Obamacare replacement.

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A one-party bill is “not the way to do it,” McCain said on “Facethe Nation" on CBS. “The way to do this is have a bill, put itthrough the committee.”

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The Senate Homeland Security and Governmental Affairs Committeehas scheduled a hearing for Sept. 26 about health-care blockgrants.

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McConnell has asked the nonpartisan Congressional Budget Officeto speed up a financial analysis of the bill, and Democrats in theSenate and House said in a letter Monday that a comprehensiveanalysis is "essential" before any vote in Congress.

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“We expect regular staff briefings and member discussions tocontinue,” David Popp, a McConnell spokesman, said in an emailMonday.

Liberal opposition

Co-sponsoring the proposal with Graham and Cassidy are ChairmanRon Johnson, a Wisconsin Republican, and Nevada Republican DeanHeller.

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House Speaker Paul Ryan has spoken positively about the bill, ashas Republican Representative Mark Meadows, chairman of theconservative House Freedom Caucus. Still, it isn’t clear that themeasure would have enough support to pass the chamber.

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Liberal groups including MoveOn.org are working to defeat theplan. The liberal Center on Budget and Policy Priorities saidFriday the bill would “significantly” cut federal funding forhealth coverage over the next decade. It said the cuts would growmore severe in 2027, when the block grants would expire andMedicaid per capita cap cuts would notch down spending. The groupestimates that in 2027 alone, federal health spending would declineby $299 billion compared with current law and all states would beaffected by cuts.

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Credit ratings agency Fitch Ratings said Friday that becauseMedicaid spending represents one-third of state budgets, the billwould pose big challenges for them, particularly those that tookadvantage of Obamacare’s Medicaid expansion.

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States ‘at risk’

“States that expanded Medicaid access to the newly eligiblepopulation under the Affordable Care Act (ACA) are particularly atrisk under this latest bill,” Fitch said. “In the short-termnon-expansion states may see gains under the bill givenredistribution of ACA related spending streams. But, over time evennon-expansion states will face budgetary challenges given theproposed changes to Medicaid, which will likely accelerate for allstates over time.”

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Republican senators from Medicaid expansion states, includingRob Portman of Ohio and Shelly Moore Capito of West Virginia, areamong those who say they’re still reviewing the legislation.

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Still, Republicans campaigned on the promise of repealingObamacare, and many don’t want to give up. They insist the blockgrants approach in the measure brings flexibility to states thatObamacare lacks. Senator John Cornyn, the No. 2 Republican leader,said last week that he’ll gauge support for the bill, and the topicis expected to be discussed again privately by Senate Republicanson Tuesday.

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Graham and Cassidy say that Pence has been telephoningRepublican senators and governors. President Donald Trump let theRepublican senators know he’s rooting for them, though he didn’texplicitly supporting the legislation.

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“I applaud the Senate for continuing to work toward a solutionto relieve the disastrous Obamacare burden on the American people,”Trump said in a statement. “Inaction is not an option, and Isincerely hope that Senators Graham and Cassidy have found a way toaddress the Obamacare crisis.”

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